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NIHR Signal Negative pressure dressings are no better than standard dressings for open fractures
Negative pressure wound dressings are neither more nor less effective than standard wound dressings for severe open fractures of the lower leg. Any difference between groups was neither clinically important nor statistically significant. The outcomes included self-rated disability at one year, quality of life and deep surgical site infections at one month which occurred in around 7-8% in each group. Open fractures of the leg, where the broken bone is exposed by the original injury or has burst ...
NIHR Signal Early, intense rehabilitation helps recovery after serious traumatic head injury
Early, intensive rehabilitation aids recovery and improves outcomes for people with moderate to severe traumatic brain injury. A review of 11 studies found that starting rehabilitation early, while people were still in intensive care, or offering more intensive treatments helped patients with brain injury regain function compared with usual care. Early rehabilitation often included multisensory stimulation while the patient was still in a coma. The intensive multidisciplinary programmes mostly ...
NIHR Signal Early use of tranexamic acid reduces bleeding more effectively
In people bleeding after trauma or giving birth, tranexamic acid within an hour of the start of bleeding increases the chances of survival by 72% compared with a placebo. Overall the trial data showed that at least six deaths from bleeding complications were prevented for every 1,000 people treated and potentially more if treatment is started early. Tranexamic acid is an antifibrinolytic drug which reduces the breakdown of blood clots and is known to reduce serious bleeding. The researchers wan...
NIHR Signal Simple preventive actions by parents linked to fewer child injuries
Education is promoted as a way to tackle the scale of avoidable injuries to young children. Children have two to five times the risk of an accident leading to injury if a parent leaves them on a raised surface, places hot drinks within reach, or does not put medicines away straight after use. For example, children are also more than twice as likely to attend hospital for falling on stairs if their parent leaves stair gates open or does not use them. In this NIHR-funded study, parental behaviou...
NIHR Signal Wearing a patch after a scratch to the eye probably makes no difference to healing
After a scratch or minor damage to the outer layer of the eye (corneal abrasion), wearing an eye patch is unlikely to reduce pain at 24 hours and might not lead to quicker healing after 24 hours. Patching the eye was compared to leaving the eye uncovered. Eye patches did not significantly affect symptoms such as eye watering, irritation, sensitivity to light or blurred vision. Corneal abrasion is usually treated using ointments or drops to reduce irritation, pain killers, and antibiotic eye dro...
NIHR Signal Drugs that stimulate bone marrow might save lives in critically ill trauma patients
Erythropoiesis stimulating agents (ESAs) might improve survival of critically ill patients after trauma. These drugs are synthetic versions of erythropoietin, a natural hormone produced by the kidneys. They boost production of red blood cells from the bone marrow; however the survival effect seems to be independent of the effect on red cell production. ESA’s are already commonly used to treat anaemia associated with chronic kidney disease. This systematic review of trials in critical trau...
NIHR Signal Building an urban motorway did not reduce traffic accidents locally
Extending the M74 motorway above Glasgow’s existing road network in 2011 has not affected the number or severity of road traffic accidents in the area. While the number of accidents fell by around 50% between 1997 and 2014, similar reductions were seen across other areas not affected by the motorway, suggesting a general trend of improved road safety. Accidents are common on the UK’s roads. Interventions to reduce the number of accidents usually focus on education (e.g. drink-drivin...
NIHR Signal Predicting severe brain injuries from apparent minor head trauma without a scan
Specific clinical decision rules applied to adults and adolescents with apparent minor head injury identified groups at low risk of severe internal head injuries, potentially reducing the number of unnecessary CT scans used in this low-risk group. For example, patients with apparent minor head injury lacking any of the features of the Canadian CT Head Rule had a probability of severe head injury of 0.31%, much lower than 7.1% for the patient group as a whole. These features were; 65 years or ov...
NIHR Signal Pre-hospital intubation of people with serious head injuries by inexperienced staff linked to increased death rate
This systematic review of patients with a serious head injury found that prehospital intubation by undertrained or inexperienced staff was linked to an increased risk of death when compared to no intubation or intubation after arrival in the hospital. Restoring an individual’s airway is a priority because lack of oxygen can cause death, brain damage and other negative outcomes, but prehospital intubation was not linked with a change in mortality generally. Staff need to be trained in intu...
NIHR Signal Unexpected results from a trial of therapeutic hypothermia for severe head injury
This NIHR-funded trial of cooling the body temperature (therapeutic hypothermia) to treat traumatic head injury was stopped early by the researchers because it appeared that the treatment might be harmful. People who have severe head injuries from trauma can suffer from injury to the brain, which can be very harmful, even fatal. Survivors of traumatic brain injury can be left with highly variable long-term effects, such as difficulty in communicating, understanding and emotional problems. This...
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